|
047H4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4D6
|
| Hospital Charge Code |
4369
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047H4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4DZ
|
| Hospital Charge Code |
4370
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047H4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4EZ
|
| Hospital Charge Code |
4371
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047H4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4FZ
|
| Hospital Charge Code |
4372
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047H4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047H4GZ
|
| Hospital Charge Code |
4373
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J041
|
| Hospital Charge Code |
2196
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J04Z
|
| Hospital Charge Code |
2197
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J05Z
|
| Hospital Charge Code |
2198
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J06Z
|
| Hospital Charge Code |
2199
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J07Z
|
| Hospital Charge Code |
2200
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0D1
|
| Hospital Charge Code |
4374
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0D6
|
| Hospital Charge Code |
4375
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0DZ
|
| Hospital Charge Code |
4376
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0EZ
|
| Hospital Charge Code |
4377
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0FZ
|
| Hospital Charge Code |
4378
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J0GZ
|
| Hospital Charge Code |
4379
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J341
|
| Hospital Charge Code |
2201
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J34Z
|
| Hospital Charge Code |
2202
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J35Z
|
| Hospital Charge Code |
2203
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J36Z
|
| Hospital Charge Code |
2204
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047J37Z
|
| Hospital Charge Code |
2205
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047J3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J3D1
|
| Hospital Charge Code |
4380
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J3D6
|
| Hospital Charge Code |
4381
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J3DZ
|
| Hospital Charge Code |
4382
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047J3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047J3EZ
|
| Hospital Charge Code |
4383
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
